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January 28 is an important day for women in Canada. Today marks the 26th anniversary of the monumental R. v. Morgentaler case, which afforded women the right to abortion, and ultimately, to take control of their body and their ability to reproduce. Before this ruling, Canadian women were only able to obtain abortions from designated hospitals and after being granted approval by the hospital’s three-doctor Therapeutic Abortion Committee.

The 1988 ruling was a long time coming for abortion activist, Dr. Henry Morgentaler, who passed away this past May. In 1967, Morgentaler presented a brief to the House of Commons on the topic of illegal abortions, stating that women should not have to risk their lives for the procedure. At this time, if a woman was not granted hospital approval, her abortion would not be performed, which forced women to turn to different, often unsafe, outlets to end their pregnancy. After this, women began reaching out to him for abortions though he refused at the time, referring women to two other doctors.

However, in 1968, knowing that Canadian women needed safer and more accessible abortion practices, he opened the first freestanding abortion clinic in Canada, the Montreal Morgentaler Clinic. In 1970, his clinic was raided by police and he was charged by authorities for performing illegal abortions.

This would be the first of many times that Morgentaler was charged for offering safe abortions to women. Throughout the early- to mid-1970s, Dr. Morgentaler was charged and acquitted multiple times for the services provided by his clinic. Despite this, in 1983, he opened two more clinics in Toronto and Winnipeg, both of which were also raided multiple times over the years.

Later that year, Dr. Morgentaler, as well as Dr. Leslie Frank Smoling and Dr. Robert Scott, were charged with performing illegal abortions during a raid of the Toronto clinic. After appealing the charges, the Supreme Court overturned section 251, the previous abortion law, in 1988.

Morgentaler, Smoling, and Scott held the position that section 251, which declared that women could only receive an abortion after an approval from an in-hospital committee, was unconstitutional based on section 7. Section 7 defends the autonomy and personal rights of Canadian citizens. There are three types of protection in this section, and Morgentaler argued that section 251 violated the security to person type. This type denotes primarily an individual’s ownership of their body, health, and psychological well-being. Because of this ruling, abortions are now considered medical procedures that are governed by the Canada Health Act rather than the criminal code.

The legacy of this case is far-reaching. Before, women’s reproduction was dictated by an in-hospital approval committee. Morgentaler fought for women’s right to make their own decisions about their body, and to have access to safe and healthy outlets. Unfortunately, on the 26th anniversary of this ruling, Canada’s abortion services still have much to be desired.

It is almost unbelievable to think that Prince Edward Island currently offers no surgical abortions. P.E.I. will cover abortions performed off-Island if they are performed in a hospital and with a referral from an in-Island doctor. It will not cover abortions taken place in private clinics. Poorer and younger women are impacted the most by P.E.I.’s lack of abortion services. Many do not have access to obtain off-Island procedures due to costs, working schedules, family pressures, transportation, and a lack of information about abortion services. The scary truth is that abortions are still done in P.E.I. Women self-induce abortion which can result in infertility, suicidal thoughts, and a decreased likelihood of pursuing academic goals.

New Brunswick’s abortion access is not much better than P.E.I. Abortions are publicly funded if they are completed in a hospital with the approval of two doctors. However, if they are performed in a clinic, the woman must pay the expenses as the province will not cover the cost of the procedure outside of publicly funded institutions. Moreover, only obstetrician/gynecologists are permitted to carry out the surgery whereas common practice in Canada is that the family physician is responsible for the procedure.

Women in rural Canada are also at an extreme disadvantage in terms of proximity and quality of abortion services. Rural physicians who perform abortions face the following obstacles: operating room scheduling; logistics; extremely long waiting lists; geographic and professional isolation from colleagues; absence of replacement providers; and fear of response from community. Often, the distance between rural areas and abortion providers is just too far for some women with less resources and/or support.

Rural communities are much less likely to have clinics dedicated solely to abortion procedures, so local hospitals and providers need to work together. Because of moral and religious opposition, this can be quite a difficult feat. Moreover, a very real problem in rural communities is the rate of burn out experienced by physicians performing these services as they are often the only provider in close proximity.

Unfortunately, it is clear that abortion and reproductive rights and services in Canada leave much to be desired. For the rights and services Canadian women do have, thank you, Dr. Henry Morgentaler. May his brave spirit be remembered, and the historical R. v. Morgentaler ruling which gave women in Canada greater choice.

As organizations who are deeply committed to the rights of women and girls, we are very concerned by recent statements regarding the Government of Canada’s refusal to fund safe abortion services abroad, including in cases of rape and for young women and girls in forced marriages. This approach represents a serious setback on women’s human rights and the health and wellbeing of survivors of sexual violence and girls in early and forced marriages.

As many as 70%of women experience physical or sexual violence in their lifetime, and the first sexual experience among up to a third of them is forced. These women are twice as likely to experience unintended pregnancies. A significant proportion of these women and girls seek to terminate these pregnancies. Legal and social barriers and a lack of availability of quality services lead to the 22 million unsafe abortions that the WHO estimates take place each year, which result in 13% of the maternal deaths that occur worldwide. Death and injury from unsafe abortion increases dramatically in conflict situations, where women and girls are often vulnerable to rape, sexual assault and other gender-based violence. In such situations, 20-50% of maternal deaths are related to unsafe abortion. UN Secretary General, Ban-Ki Moon has made clear that “access to safe emergency contraception and services for the termination of pregnancies resulting from rape should be an integral component of any multisectoral response.”

The health needs, including the sexual and reproductive health needs, of the millions of married young women and girls must also be addressed by Canadian efforts on early and forced marriage overseas. Married girls are twice as likely to experience sexual violence, encounter unwanted pregnancies and seek to terminate those pregnancies. WHO evidence shows that restrictions placed on abortion services or the lack of availability of safe services do not reduce abortion rates. They force women and adolescent girls to turn to unsafe methods and unskilled providers which can result in permanent disability or death. These deaths are entirely preventable. In low and middle income countries, complications from pregnancy and childbirth are the leading cause of death among girls aged 15-19.

The majority of countries worldwide permit abortion either in cases of rape or to preserve a woman’s mental health. Globally, 134 countries permit abortion to preserve a woman’s mental health, in cases of rape and/or upon request. Twenty-four out of Canada’s thirty-three[1] “countries of focus” for international development permit abortion on grounds of women’s mental health, rape or without restriction. Given the legal permissibility of abortion in most of these countries as well as in Canada, there is ample scope for Canadian international cooperation efforts to support increased access to safe and legal abortion services for women and adolescent girls as part of a comprehensive and integrated package of sexual and reproductive health services. According to the WHO: “Ready access to contraception and to early, safe abortion significantly reduces high rates of maternal mortality and morbidity; it prevents the costs currently imposed by unsafe abortion on health systems and on society and individuals.”

Canada’s refusal to provide women with access to safe abortion services constitutes not only a deeply troubling inconsistency with Canadian law, which permits abortion regardless of reason as an essential medical service, but also international agreements that Canada has made. In the ICPD Programme of Action and the Beijing Platform for Action, governments agreed and committed to provide women with a comprehensive package of sexual and reproductive health services, including safe abortion. Failing to provide women and adolescent girls with access to a comprehensive package of sexual and reproductive health services, which includes safe abortion, denies them their human rights, including their fundamental rights to life, to health, to bodily autonomy, to decide freely about the number and spacing of children, to self-determination, to freedom from torture, and to freedom from discrimination as well as the right to be protected from violence. By insisting that Canadian funds cannot be used to fund access to safe abortion services, Canada is complicit in the continued violation of women’s and girls’ human rights overseas.

We call on the Canadian government to:

Include access to safe abortion services as part of the package of sexual and reproductive health services funded by Canadian international cooperation initiatives;

Support effective strategies to ensure that survivors of sexual violence and young women and girls in early and forced marriage have access to a comprehensive package of sexual and reproductive health services, including safe abortion; and

Produce clear policy for Canada’s international initiatives that adopts a human rights-based approach to sexual and reproductive health.

The lives of women around the world, particularly survivors of sexual violence and married young women and girls, depend on their access to a life-saving service. Canada can be a leader on these issues: let’s not let women and girls down.